HAVING A FAMILY DURING RESIDENCY

What you Need to Know

If you are pregnant or planning to start a family, you likely have questions about how pregnancy and maternity leave will impact you as a Canadian medical resident. This resource contains information to help you prepare for maternity leave, scale back your professional duties, obtain financial supports, and re-enter the workforce as a resident. We’ve also provided recommended resources for parents, including websites, blogs, and podcasts.

Please note that each province and program will have unique policies and supports that you should look into. We have provided links to many of these as well.

If you are planning to start a family or are already pregnant, be sure to attend to the following things:

See your family doctor or find a family doctor if you don’t have one already. Most provincial medical associations have support programs that will assist you with the process of finding a family doctor.

Notify your residency program director as soon as you are ready to do so. In most cases, earlier is better. It can be helpful to do so before you are through the first trimester, in order to facilitate planning your rotations, maternity leave, and coverage of call during your second and third trimester. Sit down with your program director and have a look at upcoming rotations. In many cases, adjustments to rotations with heavy on-call requirements and high physical demands may be needed especially in the third trimester.

Plan for child care, as the process of securing child care can take upwards of a year. Particularly if you are considering putting your child in day care or hiring a foreign nanny, start putting your name on the wait lists or get connected with a hiring agency as soon as possible. Although many residents find childcare towards the end of their maternity leave it can become a significant source of angst and worry.

Notify your Post Graduate Medical Office.

Contact the wellness office at your university for local resources and to help guide you through the process.

Apply for Canada’s Employment Insurance (EI) though Service Canada or QPIP (Quebec) once the baby is born, or sooner if you’ve elected to start maternity leave prior to your due date.

Maternity Leave Suspends Your Practice

Note that, when you are on maternity leave, your clinical privileges are essentially suspended, including extender licenses. While on leave, you are not legally covered to be involved in any kind of patient-care activities.

Common day-to-day exposures in medicine can present increased risks to pregnant mothers and fetuses. The actual risks of many exposures are largely based on animal studies and they are not likely to be studied in a randomized fashion in humans. Therefore, as a pregnant resident you are recommended to gauge your own comfort with substances and situations encountered as part of your job.

In many circumstances, you may avoid the exposure by adjusting your rotation schedule or having a colleague see a patient. The National Center on Birth Defects and Developmental Disabilities (NCBDDD) website provides a list of exposures to should consider, with links to information that can help you make an informed decision.

Heavy lifting is defined as repetitive lifting or carrying or lifting greater than 23 kg.

Excessive standing or walking is defined as standing for greater than three to four hours a day.

The Alberta Perinatal Health Program’s consensus is that eliminating heavy lifting by the 20th week of pregnancy, and eliminating excessive standing by the 24th week of pregnancy, reduces the risk of adverse perinatal outcomes to those of unexposed women.

If you are expecting multiples, speak with your physician. You may be advised to abstain from call duty earlier than during a singleton pregnancy.

Provincial Policies for Pregnant Physicians

Each province and program has unique policies regarding on-call and extended shifts during pregnancy. The table below shows the number of gestational weeks at which a pregnant physician is no longer required to fulfill extended shifts and on-call duty in each province. Links to each province’s complete policy are also given.

Most Canadian residents pay into Canada’s Employment Insurance program (EI). EI provides an income to mothers who have given birth and/or parents looking after a newborn in the first year of life. You must accumulate at least 600 insurable employment hours (excluding on-call and after-hours coverage) to qualify: https://www.canada.ca/en/services/benefits/ei/ei-maternity-parental.html

As of 2017, EI provides a maximum benefit of $547 per week before taxes.

The first 17 weeks of this leave is considered maternity leave and is offered to biological mothers including mothers who are pregnant or have recently given birth.

The following 35 weeks of the program is considered parental leave and is offered to parents who are caring for a newborn or newly adopted child.

The combined programs give birth mothers a total of 52 weeks, or 1 year, of benefits.

Provincial Top-Ups

Many provincial residency contracts provide additional financial support to birth mothers, called a “top-up”. Others may substitute a resident’s EI benefit for the maternity portion of her leave. This is often paid in a lump sum at the end of the 17-week maternity portion.

Quebec residents pay into something similar to EI benefits as above, the Quebec Parental Insurance Plan (QPIP). Residents are eligible after 20 weeks of service: http://www.rqap.gouv.qc.ca/index_en.asp

There are many nuances within each province’s plans, so refer to your provincial residency association for the details. The table below summarizes what the provincial contracts provide as of May 2016.

Table 2: Summary of Leave Provisions by Province

BC

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

Maritimes

Newfoundland and Labrador

Maternal leave

No top up; EI only

17 weeks = 90% when combined with EI

17 weeks = 95% when combined with EI

17 weeks = 60% gross wages up to $1,200 a week

15 weeks = 84% when combined with EI

21 weeks = 95% pay when combined with QPIP

15 weeks top up = 93% pay when combined with EI

No top up; EI only

Paternal/adoptive parent

EI parental leave only

2 weeks 100% then EI parental leave

5 days 100% pay then EI parental leave

As above

10 weeks = 84% pay when combined with EI

5 days at the time of birth paid leave then QPIP up to 38 weeks

10 weeks = 93% pay when combined with EI

EI parental leave only

Support for Fathers, Same-Sex Partners & Adoptive Parents

Male residents having a child, same-sex partners caring for a newborn, and residents who are adopting a child qualify for benefits under the EI parental leave program up to 35 weeks and often have protected unpaid leave for up to 52 weeks. Not all programs have a comparable top-up available for fathers, same-sex partners or adoptive parents.

A few weeks prior to your return to work, you should take care of the following:

Contact your post-graduate medical education office and health authority to confirm your return date. You may also need to contact your human resources department to confirm your return date and ensure that payments are not delayed.

Access to hospital computer systems may be cut off during your maternity leave. Therefore, contact your local IT department several weeks in advance of your return to get your passwords reset and restore access to clinical tools necessary for patient care.

Adjusting to Your Return to Work

When returning to work after maternity leave, it’s normal to feel overwhelmed. You may also feel disconnected from your peers and you may feel that other residents do not relate to what you are going through.

Be assured that many residents have succeeded in this transition. Most provinces and universities have wellness offices that can help with the transition or any time issues arise. Returning to residency part-time is sometimes a possibility and may be worth exploring. Ask for help when you need it.

“The first month back will most likely be a HUGE adjustment period both at home and at work. It’s normal to feel totally overwhelmed, feeling like a terrible mom/wife/doctor on a regular basis, but this gets better with time! Be kind to yourself, spend lots of time with your kid(s) when you get home after work, and save the studying for after bedtime. And don’t forget self care! I have been very upfront with my current preceptor about my needs to pump, and to occasionally even go home to breast feed, and they have been more than accommodating.” – Samantha Reaume, Family Medicine

Nursing

It is possible to continue nursing as you make the transition back to work. Having a double electric breast pump is helpful for pumping milk during the day in the shortest amount of time possible. Most pumps also come with freezer containers to store the milk if access to refrigeration is limited.

Hospitals are required to provide you with a space to pump. Still, some residents experience challenges finding a space to pump, and many organizations lack policies around breastfeeding. Some residents have found it helpful to contact one of the lactation consultants at the hospital where they are providing service to assist with getting access to a private space.

Transitioning to cow’s milk can be done at 9 months of age as per the Canadian Association of Pediatrics.

Childcare

For many, obtaining reliable childcare is the most nerve-wracking part of the transition back to work. This is especially true for residents who lack family supports in the community in which they are training. Options for childcare include: daycares, day homes, foreign nannies, au pairs, local nannies, and nanny-on-call companies.

Daycares have long waiting lists and often require you put your name on a list more than one year in advance. Many have extended hours to accommodate university students and working parents. Pay attention to consequences for late fees if you are unable pick up your child on time. Note that some day cares will refuse to let your child attend if they are ill.

Day homes may be somewhat more flexible in terms of the hours to pick up your child. Some residents have had issues with day homes providing little notice for extra vacation time or days they will not be providing care. Note that not all day homes are regulated, although most provinces have regulatory agencies that accredit certain day homes.

Hiring a foreign nanny takes upwards of one year and has many upfront costs, such as $1,000 to obtain a Labour Market Impact Assessment (LMIA) and flights to Canada. Many residents use an agency to assist with the process. These caregivers often assist with meal prep and light household cleaning. Their hours are often more flexible than daycares or day homes and alternate childcare doesn’t usually need to be found if the child is sick. However, nannies also get sick sometimes and you are required to provide vacation. Note that it is no longer legal to require your nanny to live in, after federal changes to the program in 2014.

Hiring an au pair is an option for temporary child care. Au pairs are often students looking for an exchange experience to another country and provide child care in exchange for accommodations. The hours an au pair will work are often more limited, and placements are more temporary.

Hiring a local nanny has the benefit that you can interview locally and in person. Rates for local nannies are often higher than for foreign nannies. Many foreign nannies look for work independently once their contracts end with their current employer. Some may require the LMIA mentioned above to legally work in Canada.

Some cities have nanny-on-call companies which can be useful in situations where your childcare falls through at the last moment: http://www.nanniesoncall.com

Mothers in Medicine, a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding:http://www.mothersinmedicine.com/